高频叠加喷射通气在肺外周结节支气管镜活检中的应用  

High-frequency jet ventilation in bronchoscopic biopsy of peripheral pulmonary nodules

作　　者：沈艳丽 王清洋 唐培[1] 李金金 陈献亮[1] SHEN Yanli;WANG Qingyang;TANG Pei;LI Jinjin;CHEN Xianliang(Department of Pulmonary Medicine,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 451464,China;Department of Anesthesia and Perioperative Medicine,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 451464,China)

机构地区：[1]河南省人民医院,阜外华中心血管病医院呼吸内科,河南郑州451464 [2]河南省人民医院,阜外华中心血管病医院麻醉与围术期医学科,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2024年第1期70-74,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210126)。

摘　　要：目的 观察高频叠加喷射通气在LungPro导航支气管镜肺外周结节活检中的应用价值,探讨其安全性。方法 2022年1月—2023年6月河南省人民医院行支气管镜活检肺外周结节患者160例,80例采用常规通气者为常规导航组,80例采用高频叠加通气者为高频通气导航组。2组均应用LungPro导航系统,依据胸部CT扫描数据重建肺部3D数字模型,自动生成到达病灶的支气管镜路径。高频通气导航组全身麻醉后采用高频叠加喷射通气,常规导航组全身麻醉后采用常规麻醉机通气,按照导航规划路径行支气管镜肺外周结节活检。记录2组支气管镜到达病灶时间、总操作时间、到达病灶成功率、实际活检部位与导航路径匹配率、术中出血及气胸发生情况。支气管镜组织活检病理诊断为恶性结节和诊断不明确者均行胸腔镜手术治疗,记录术后组织病理检查结果,比较2组支气管镜活检明确诊断率、恶性诊断准确率和良性诊断准确率。结果 (1)2组性别比例、年龄、结节大小、结节性质、结节所在支气管分级、结节与支气管位置关系比较差异均无统计学意义(P>0.05)。(2)常规导航组成功到达病灶66例,高频通气导航组成功到达病灶77例,2组成功到达病灶者中各有3例实际活检部位与导航路径不匹配。高频通气导航组支气管镜到达病灶时间[(3.4±1.1)min]、总操作时间[(14.5±3.7)min]均短于常规导航组[(5.7±1.6)、(16.8±4.2)min](t=10.595,P<0.001;t=3.675,P<0.001),到达病灶成功率(96.25%)、实际活检部位与导航路径匹配率(92.50%)均高于常规导航组(82.50%、78.75%)(χ^(2)=7.964,P=0.005;χ^(2)=6.144,P=0.013)。(3)常规导航组支气管镜组织活检病理明确诊断59例,未明确诊断21例(14例未成功到达病灶,7例到达病灶未取到有效病灶组织)。高频通气组支气管镜活检明确诊断71例,未明确诊断9例(3例未成功到达病灶,6例到达病灶未取到有效病灶组Objective To observe the application of high-frequency jet ventilation(HFJV) in LungPro-guided bronchoscopic biopsy in patients with peripheral pulmonary nodules,and to investigate its safety.Methods In 160patients with peripheral pulmonary nodules receiving LungPro-guided bronchoscopic biopsy in Henan Provincial People's Hospital from January 2022 to June 2023,80 patients used routine navigation(routine navigation group) and 80 patients used HFJV(HFJV group).According to chest CT scan results,3D digital lung model was reconstructed in both groups,and the bronchoscopic path to the lesion was automatically generated.HFJV was applied after general anesthesia in HFJV group,and ventilation was connected to the general anesthesia machine after anesthesia in routine navigation group.The bronchoscopic biopsy of peripheral pulmonary nodules were performed according to the navigation path in both groups.The arrival time,total operation time,navigation success rate,matching rate between the actual biopsy site and the navigation path,intraoperative bleeding and pneumothorax were recorded in two groups.All patients with bronchoscopic biopsy confirmed malignant or undefined diagnosis were performed thoracoscopic surgery.The results of histopathology were recorded,and the diagnostic rates of bronchoscopic biopsy and the diagnostic accuracies of malignant and benign nodules were compared between two groups.Results(1) There were no significant differences in the gender ratio,age,nodule size,nodule nature,bronchial classification of nodules,and relationship between the nodule and the position of the bronchi between two groups(P>0.05).(2) Bronchoscope reached the lesions successfully in 66 patients in routine navigation group and 77 patients in HFJV group.The actual biopsy sites of 3 patients among whom bronchoscope reached the lesions successfully in each group did not match the navigation path.The arrival time and total operation time were shorter in HFJV group [(3.4±1.1),(14.5±3.7) min] than those in routine navigation group

关 键 词：肺外周结节 支气管镜活检 高频叠加喷射通气 LungPro导航系统 

分 类 号：R563[医药卫生—呼吸系统]